Longitudinal Trends in Glycemic Outcomesand Technology Use for Over 48,000 People with Type 1Diabetes (2016–2022) from the Type 1 Diabetes ExchangeQuality Improvement Collaborative
Objective: Previous studies revealed that hemoglobin A1c (HbA1c) increased overall in the United States in thepast decade. In addition, health inequities in type 1 diabetes (T1D) outcomes by race/ethnicity and insurancetype persist. This study examines the trends in HbA1c from 2016 to 2022 stratified by race/ethnicity andinsurance in a large multicenter national database.
Research Design and Methods: We analyzed glycemic outcomes and diabetes device use trends for>48,000people living with type 1 diabetes (PwT1D) from 3 adult and 12 pediatric centers in the T1D Exchange QualityImprovement Collaborative (T1DX-QI), comparing data from 2016 to 2017 with data from 2021 to 2022.
Results: The mean HbA1c in 2021–2022 was lower at 8.4% compared with the mean HbA1c in 2016–2017 of8.7% (0.3% improvement ;P<0.01). Over the same period, the percentage of PwT1D using a continuous glucose monitor (CGM), insulin pump, or hybrid closed-loop system increased (45%, 12%, and 33%, respectively). However, these improvements were not equitably demonstrated across racial/ethnic groups or insurance types. Racial/ethnic and insurance-based inequities persisted over all 7 years across all outcomes; comparing non-Hispanic White and non-Hispanic Black PwT1D, disparate gaps in HbA1c (1.2%–1.6%), CGM(30%), pump (25%–35%), and hybrid-closed loop system (up to 20%) are illuminated.
Conclusion: Population-level data on outcomes, including HbA1c, can provide trends and insights into strat-egies to improve health for PwT1D. The T1DX-QI cohort showed a significant improvement in HbA1c from2016 to 2022. Improvements in diabetes device use are also demonstrated. However, these increases wereinconsistent across all racial/ethnic groups or insurance types, an important focus for future T1D populationhealth improvement work
Keywords: HbA1c, Quality improvement, Type 1 diabetes, Real-world data, Health equity, Learning healthsystem
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